Psychosocial predictors of treatment response to cognitive-behavior therapy for late-life depression: an exploratory study

Abstract

Objective: The primary objective of this study was to examine a variety of potential predictors of response to Cognitive Behavioral Therapy (CBT) in depressed older adults.

Method: Sixty older adults with a clinical diagnosis of major or minor depression or dysthymic disorder received 12 individual sessions of CBT over a three- to four-month-period. The BDI-II was administered pre- and post-intervention to assess change in the level of depression. A cutoff score of 13 or less at post was used to determine positive treatment response. A variety of measures (obtained at baseline) were evaluated using hierarchical regression techniques to predict improvement following treatment.

Results: Individuals who showed greater improvement were: (a) more open to new experiences; (b) less negatively affected by past stressors; (c) less inclined to have an external locus of control but more likely to cite others as responsible for negative stress in their lives; and (d) were more likely to seek emotional support when symptomatic. Lower education level and reported use of active coping strategies at baseline were associated with less improvement. Other variables (e.g., age, overall physical health, and cognitive status) were not associated with treatment response. Use of logistic regression to predict responders vs. nonresponders yielded a similar pattern.

Conclusion: These findings agree with prior research confirming the effectiveness of a brief CBT intervention for older depressed persons and suggest further exploration of several psychosocial factors that may contribute to a stronger response to CBT.

Keywords:

• cognitive behavior therapy
• CBT
• depression
• older adults
• trauma
• response predictors

Acknowledgements

This study was funded by an NIMH Exploratory/Developmental Research Grant Program (R21 MH091625-01 entitled: ‘Predictors of Positive Outcome In Cognitive Behavior Therapy For Late Life Depression’).

Notes

*Not all participants provided answers in these categories.

^a Model 1 includes predictors: (constant), BDI-II baseline total.

^b Model 2 includes all additional predictors: (constant), total baseline BDI-II score, external locus of control for changing stressful events, age, impact of stressful events, internal locus of control for changing stressful events, extroversion, MMSE, emotional support, years of school completed, total of recent stressful incidents, physical health, Assuming responsibility for the occurrence of the stressful situation (internal blame), denial, openness, attributing responsibility to others for the occurrence of the stressful situation (external blame), social support, neurotiscism, integration of stressful life events, active coping.

Note: ¹Variable from the study's demographics survey. ²Variables from the Big Five Inventory (John, Naumann & Soto, 2008). ³Variable from the Health Questionnaire (SF-12v2) (Ware, Kosinski and Keller, 1996). ⁴Baseline total from The Abbreviated Duke Social Support Index, (Koenig et al., 1993). ⁵Baseline total from the Elders Life Stress Inventory (Aldwin, 1990). ⁶Variables based on locus of control theory (Canton, 2007; Rotter, 1966). ⁷Baseline total score from The Impact of Events Scale-6 (IES-6) (Thoresen et. al, 2010). ⁸Variable from the Brief Cope (Carver, 1997). ⁹Baseline total from the Integration of Stressful life Events Scale (Holland et al, 2010).

*p < .05. **p < .01.